Dustin Michael Davis, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D11447 Issued in OR

Practice address

11411 SE Sunnyside Rd Ste 101
Clackamas, OR 97015-9356

Phone

(503) 855-5100

NPI assigned

Mar 19, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eric E Jacobsen DDS PC

  • Pediatric Dentistry
  • Oregon City, OR
  • NPI 1225678139
  NPD (past)
• Sunnyside Dentistry for Children, P.C.

  • Pediatric Dentistry
  • Clackamas, OR
  • NPI 1104156959
  NPD (past)
• Paul Lund DDS PLLC

  • Pediatric Dentistry
  • Lake Stevens, WA
  • NPI 1255735734
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1063787497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11411 SE SUNNYSIDE RD STE 101",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159356",
            "telephone_number": "951-526-5452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11411 SE SUNNYSIDE RD STE 101",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159356",
            "telephone_number": "503-855-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DUSTIN",
        "middle_name": "MICHAEL",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-19",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00202313",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60650351",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11447",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029333",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Tyler Darnell, M.D.
• David Rheaume, DC.PC
• David W. Compton, DMD, Ms, PC
• Jill Davies
• Daniel Wade Davis, M.D.
• Karley Davis, LMT
• Lisa Charlene Davis
• Lynn Carol Davis, CRNA
• Patrick Davis
• Elizabeth Davitt, MS, RDN

• Pediatric Dentistry in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.